Parathyroidectomy May Decrease Mortality Risk in Secondary Hyperparthyroidism

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Hemodialysis patients who undergo the procedure experience decreased risks of all-cause and cardiovascular mortality.
Hemodialysis patients who undergo the procedure experience decreased risks of all-cause and cardiovascular mortality.

Hemodialysis patients who undergo parathyroidectomy for severe, uncontrolled secondary hyperparathyroidism are at significantly lower risk for all-cause and cardiovascular (CV) mortality, according to a Japanese study.

In a retrospective study, Hirotaka Komaba, MD, of Tokai University School of Medicine in Isehara, and colleagues compared 4,429 hemodialysis patients with severe secondary hyperparathyroidism who underwent a parathyroidectomy and 4,428 propensity score-matched hemodialysis patients who did not despite severe secondary hyperparathyroidism. 

The 1-year all-cause and CV mortality rates was 4.3% and 1.8% in the parathyroidectomy group, respectively, compared with 6.5% and 3.1%, respectively, in the matched control group, the investigators reported in Kidney International

In a fully adjusted model, the parathyroidectomy patients had a 22% and 29% lower risk for all-cause and CV mortality during a 1-year follow-up, respectively, compared with the matched controls.

The researchers acknowledged that only a randomized controlled trial could definitively determine the survival benefit of parathyroidectomy. In light of the apparent clinical effects of parathyroidectomy on secondary hyperparathyroidism-related symptoms, however, conducting such trials in patients with uncontrolled, severe secondary hyperparathyroidism would be viewed as unethical. 

“Given this, our findings have important implications in the management of severe [secondary hyperparathyroidism] and provide an additional basis to support the current international or national guidelines that suggest or recommend [parathyroidectomy] for patients with refractory [secondary hyperparathyroidism],” the researchers concluded. 

Reference

  1. Komaba H et al. Kidney Int. 2015;88:350–359.
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